Everyday, and probably every moment, doctors delegate duties and tasks to supporters.  We have to understand what delegation means to the responsibility doctors.  The author would also put up an analogy, hopefully only interesting but not too provocative.

Usually a doctor considers it delegation when he assigns a duty to a junior doctor working under his wings.  He also expects the respondent to report events back afterwards.

A doctor has delegated duty when he asks his clinic staff or support nurse to reply a call, report a test, dispense medication, give injection, write a laboratory request form, ask part of the history (including important areas such as drug allergy)…. , actually any request which reaches him in professional contexts.

It is important to understand that responsibility stays when physical work is delegated.  When a doctor asks a staff to help him draft a report, he bears the professional responsibility that the report is right – down to a-an-the, left-right-side-matters, number of lesions, name of subject…, in fact anything and everything.  If the report is wrong, the doctor may be summoned by the Medical Council, not the helper.

When a doctor asks a nurse to ask about history of allergy, and trusts ‘the system’, be it the nurse, the computer, he still bears the same weight with professional responsibility when he prescribes.  Our professional courts is only interested in the doctor, never his assistant(s).

When a doctor asks the nurse or another to assess a patient for him, he should have an opinion that his helper has adequate ability to fulfill the task, or he has asked questions specific enough to enable the respondent to handle his request while still safeguarding the patient.

In most private outpatient outlets, the doctor has a duty to check prescribed medications.  He has to positively identify each bag of drug as tallying to a prescribed item, but not just that ‘it should be there’.  A bag of drug reaching the patient is either cure to a problem and solution to trouble, or evidence of malpractice.  When the doctor delegates it to any staffs, he still bears the final blame if things go wrong.

When a doctor asks his nurse to reply a call, it might be safe to write down his instructions about words to use, sequence with presentations, and even answers to “what-if’s”.  If the client has an emergency and the middle person has not enough ability to recognize it, it may be argued that the doctor has not discharged his duty well.

So, what is our analogy?

Next time, when a doctor is delegating any duty, imagine this speech:

Doctor: Nurse Nancy, please answer the patient about the question she sent to me, and ask her to do so and so.  (And then he takes his annual practicing certificate which he just received from his inbox.) Here this is, my licence to practice medicine. Please take it with you and the patient will cooperate with you.  Please do not fold it and take it back to me after you finish using it.  (Or, worse).  Please do tasks 2 to 10 afterwards for me, taking my licence together.

It is an art to judge whether our supporters may accomplish a task.  It is also an art to decide whether a task is simple enough to be delegated or not.  Take care, my brothers and sisters.

When I was seeing patients, I asked myself one very important question when I was given any task especially in professional contexts: should I do it myself.  I had a conscious answer to each occasion at each time, however busy I was.  Many a time, I answered a patient’s call myself, often surprising her, especially when I consider the message a bit difficult to convey, or when I thought the patient placed high value to the answer.  It was not a waste of time because the interaction built rapport and fostered trust between the patient and me.  I asked each patient history of allergy nearly each prescription.  I wrote every letter myself (reply, admission, operation, etc), and nurses may also remember that I filled up many imaging request forms.  I delegate, but only carefully.